HIV Infection Is Associated With Diffusing Capacity Impairment in Women

Fitzpatrick, Meghan; Gingo, Matthew R.; Kessinger, Cathy; Lucht, Lorrie; Kleerup, Eric C.; Greenblatt, Ruth M.; Claman, David M; Ponath, Claudia; Fong, Serena; Huang, Laurence; Morris, Alison

doi:10.1097/qai.0b013e3182a9213a

Cited by 49 publications

(76 citation statements)

References 36 publications

(45 reference statements)

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“…As people were not randomly selected to participate, recruitment bias is possible. Spirometry was our only objective measure of lung function, whereas several studies have suggested that impairment of gas transfer is more common than airflow obstruction in PLWH [28,29]. The differences in age and ethnicity between groups could have influenced our results; however, our findings persisted after adjustment in multivariable analyses; and our sensitivity analysis is reassuring in that the difference in age distribution between HIV-positive and HIV-negative participants appeared to have little impact on the results.…”

Section: Discussioncontrasting

confidence: 52%

Respiratory health status is impaired in UK HIV‐positive adults with virologically suppressed HIV infection

et al. 2017

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We sought to evaluate whether people living with HIV (PLWH) using effective antiretroviral therapy (ART) have worse respiratory health status than similar HIV-negative individuals. MethodsWe recruited 197 HIV-positive and 93 HIV-negative adults from HIV and sexual health clinics. They completed a questionnaire regarding risk factors for respiratory illness. Respiratory health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) breathlessness scale. Subjects underwent spirometry without bronchodilation. ResultsPLWH had worse respiratory health status: the median SGRQ Total score was 12 [interquartile range (IQR) 6-25] in HIV-positive subjects vs. 6 (IQR 2-14) in HIV-negative subjects (P < 0.001); breathlessness was common in the HIV-positive group, where 47% compared with 24% had an MRC breathlessness score ≥ 2 (P = 0.001). Eighteen (11%) HIV-positive and seven (9%) HIVnegative participants had airflow obstruction. In multivariable analyses (adjusted for age, gender, smoking, body mass index and depression), HIV infection remained associated with higher SGRQ and MRC scores, with an adjusted fold-change in SGRQ Total score of 1.54 [95% confidence interval (CI) 1.14-2.09; P = 0.005] and adjusted odds ratio of having an MRC score of ≥ 2 of 2.45 (95% CI 1.15-5.20; P = 0.02). Similar findings were obtained when analyses were repeated including only HIV-positive participants with a viral load < 40 HIV-1 RNA copies/mL. ConclusionsDespite effective ART, impaired respiratory health appears more common in HIV-positive adults, and has a significant impact on health-related quality of life.

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Section: Discussioncontrasting

confidence: 52%

Respiratory health status is impaired in UK HIV‐positive adults with virologically suppressed HIV infection

et al. 2017

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“…11,47,52,53 DLCO of less than 80% predicted was present in 64% of HIV-infected patients from one study, 11 and was independently associated with greater numbers of pack-years smoked, and use of pneumocystis prophylaxis (an indicator of lower CD4 cell counts), but not ART use. 11 In an analysis of 300 HIV-infected men and 289 HIV-uninfected men from the Lung-HIV cohort, 54 a moderate to severe reduction in DLCO was noted in 30% of HIV-infected patients compared with 18% of HIV-uninfected people (p<0·001).…”

Section: Abnormalities In Pulmonary Function Tests In Patients With Hivmentioning

confidence: 94%

HIV-associated obstructive lung diseases: insights and implications for the clinician

Drummond¹,

Kirk²

2014

The Lancet Respiratory Medicine

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The effectiveness of antiretroviral therapy to control HIV infection has led to the emergence of an older HIV population who are at risk of chronic diseases. Through a comprehensive search of major databases, this Review summarises information about the associations between chronic obstructive pulmonary disease (COPD), asthma, and HIV infection. Asthma and COPD are more prevalent in HIV-infected populations; 16–20% of individuals with HIV infection have asthma or COPD, and poorly controlled HIV infection worsens spirometric and diffusing capacity measurements, and accelerates lung function decline by about 55–75 mL/year. Up to 21% of HIV-infected individuals have obstructive ventilatory defects and reduced diffusing capacity is seen in more than 50% of HIV-infected populations. Specific pharmacotherapy considerations are needed to care for HIV-infected populations with asthma or COPD–protease inhibitor regimens to treat HIV (such as ritonavir) can result in systemic accumulation of inhaled corticosteroids and might increase pneumonia risk, exacerbating the toxicity of this therapy. Therefore, it is essential for clinicians to have a heightened awareness of the increased risk and manifestations of obstructive lung diseases in HIV-infected patients and specific therapeutic considerations to care for this population. Screening spirometry and tests of diffusing capacity might be beneficial in HIV-infected people with a history of smoking or respiratory symptoms.

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“…Chronic lung diseases, such as COPD, have long been postulated to have an infectious component. COPD is an important cause of respiratory impairment in HIV-infected persons, and HIV infection is an independent risk factor for COPD (6,13,40). Pulmonary infections could stimulate replication of HIV in the lungs, augment pulmonary inflammation, and cause lung destruction by release of proteases, thereby leading to or worsening COPD (41).…”

Section: Discussionmentioning

confidence: 99%

“…Fifty-six participants were recruited at the University of Pittsburgh, the University of California San Francisco, and the University of California Los Angeles (6,13). Subjects were outpatients not experiencing an acute change in respiratory symptoms in the prior 4 weeks and had not received antibiotics in the previous 6 months.…”

Section: Methods Study Participantsmentioning

confidence: 99%

Topographic Diversity of the Respiratory Tract Mycobiome and Alteration in HIV and Lung Disease

Cui

Lucht

Tipton³

et al. 2015

Am J Respir Crit Care Med

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117

120

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Rationale: Microbiome studies typically focus on bacteria, but fungal species are common in many body sites and can have profound effects on the host. Wide gaps exist in the understanding of the fungal microbiome (mycobiome) and its relationship to lung disease.Objectives: To characterize the mycobiome at different respiratory tract levels in persons with and without HIV infection and in HIVinfected individuals with chronic obstructive pulmonary disease (COPD).Methods: Oral washes (OW), induced sputa (IS), and bronchoalveolar lavages (BAL) were collected from 56 participants. We performed 18S and internal transcribed spacer sequencing and used the neutral model to identify fungal species that are likely residents of the lung. We used ubiquity-ubiquity plots, random forest, logistic regression, and metastats to compare fungal communities by HIV status and presence of COPD.

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HIV Infection Is Associated With Diffusing Capacity Impairment in Women

Cited by 49 publications

References 36 publications

Respiratory health status is impaired in UK HIV‐positive adults with virologically suppressed HIV infection

Respiratory health status is impaired in UK HIV‐positive adults with virologically suppressed HIV infection

HIV-associated obstructive lung diseases: insights and implications for the clinician

Topographic Diversity of the Respiratory Tract Mycobiome and Alteration in HIV and Lung Disease

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